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Part One: Xenon Gas and High-Altitude Performance in conversation with Dr. Peter Hackett
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In this episode, host Steve House sits down with Dr. Peter Hackett, a pioneer in high-altitude medicine, to discuss the potential use of xenon gas as a performance enhancer for mountaineers. Xenon, once used as an anesthetic, is a noble gas that may briefly stimulate erythropoietin (EPO) but lacks solid evidence of improving red blood cell count or performance. Dr. Hackett explains the risks of unsupervised xenon use and stresses the importance of controlled research before drawing conclusions. He shares skepticism around current anecdotal claims, especially without peer-reviewed data. The episode emphasizes safety, science, and honesty in altitude medicine. This is the first part of a two-part series on the use of Xenon in mountaineering.
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Transcript
Introduction to High Altitude Medicine and Dr. Hackett
00:00:00
Speaker
What's the big rush? You don't need any drugs. Just plan an extra week on your trip and take time to acclimatize and you'll be very comfortable and you won't get sick.
00:00:20
Speaker
Today's guest is a true legend in both the world of high altitude medicine and mountaineering. Dr. Peter Hackett is a board certified emergency physician, a pioneering researcher, and someone whose work has shaped how we understand and treat the effects of high altitude on the human body.
00:00:37
Speaker
Peter was part of the American Medical Research Expedition to Everest in 1981 and became the 111th person. Is that correct, Peter? 111 person to summit Everest solo from the South call, no less.
00:00:51
Speaker
And over the past four decades, Peter has dedicated his career to studying altitude illness and human performance in extreme environments. He has published over 100 papers in peer-reviewed journals and founded the Institute for Altitude Medicine based in Telluride, Colorado.
00:01:08
Speaker
Peter has treated climbers on Denali, on Everest, on Aconcagua, and when he's not away on an expedition, he may be found backstage at a Rolling Stones concert serving as the band's tour doctor.
00:01:21
Speaker
From the summit of Everest to the front row of rock and roll, Peter who has probably seen it all. And you may not remember this, Peter, but you were the lead instructor on the first Rulerns First Responder course I took, I think it was 1991 in Yosemite Valley.
00:01:39
Speaker
And AMGA organized the course and, you know, learning from you but from the first time about high altitude was was a dream for me as a as a young 20 year old mountain guide at that time, aspiring mountain guide. So welcome to the show, Peter. Thank you for being here.
00:01:59
Speaker
Great to be here.
00:02:03
Speaker
So today I want to talk about Xeon, particular subject, and we're bringing you on obviously for your breadth of experience, but also you have this really unique perspective as a mountaineer, as i medical doctor, as a researcher, so specifically around the effects of high altitude and high altitude illnesses.
Exploring Xenon Gas and Its Uses
00:02:32
Speaker
And One of the things I want to help people understand is just what xenon is. So while I definitely want to hear a story about touring with the stones, let's start from the top. What exactly is xenon gas and how does it interact with the body on a physiological level? What do we know?
00:02:51
Speaker
Yeah, good place to start. you You know, xenon is one of the ah noble gases. It's a part of the atmosphere. It's a very rare atmospheric gas. About one in 10 million parts of the atmosphere is made up by xenon as opposed to, you know, ah the other noble gases are argon and krypton and helium and are even more common than that.
00:03:18
Speaker
It's the noble gases are thought not to be ah chemically reactive. They're considered to be inert, which is interesting, but they do have ah physiological effects. So they seem to act on molecules, especially certain receptors in the in the body.
00:03:39
Speaker
And... ah You know, Xenon, it was discovered in 1898. It was air. purified from liquefied air And it was used initially as an anesthetic agent.
00:03:53
Speaker
It is still an anesthetic agent. It's used to promote, do well, to provide anesthesia in Russia quite a bit. The Russians have quite a bit of experience with it. It was used in the U.S. in the 30s and 40s. And it's very similar to nitrous oxide.
00:04:08
Speaker
It has some similarities to ketamine. ah It has similarities to cyclopropane, which is a more common anesthetic. One of the main reasons it's not used as an anesthetic anymore is that it's so expensive.
00:04:24
Speaker
Much, much more expensive than any of the other anesthetic gases. But it's safe when it's used by an anesthesiologist and it's effective as an anesthetic.
00:04:36
Speaker
And um somewhere along the line, the Russians ah did some work and found that it...
Limitations of EPO and Oxygen's Role
00:04:48
Speaker
stimulated EPO and they started, yeah they were known to, it was an open secret that they were using at the Sochi Winter Olympics in 19, when was And that's it ah that's when it started to percolate into other circles as a possible blood doping agent or performance enhancing agent. Mm-hmm.
00:05:11
Speaker
Okay. Interesting. So do we know when you say it's a light nitrous oxide, what does that mean? That they puts me to sleep if I breathe? Yes.
00:05:22
Speaker
Absolutely. Okay. And it numbs pain? Yeah. Well, yeah. It puts you totally out. um Okay. Yeah. it's ah It acts on NMDA receptors of the brain, which is a little different than some of the other anesthetics, but it's the same receptors as nitric oxide and similar to ketamine.
00:05:43
Speaker
So any of these agents, you know, sad they're obviously dose-related. ah And the Russians used it mainly. did They give a high enough dose, like maybe 50% or 70% xenon gas in air or oxygen.
00:05:59
Speaker
It's enough to put you out for surgery for a long time. And then they take the gas away and you wake up. So the effect is is fairly ah temporary. It stays in the body.
00:06:11
Speaker
You can find traces of it in the body for about three hours. Right. Okay, interesting. And so the the the xenon oxygen mixture is administered through the whole surgery in the case of its use as a surgical anesthetic, and then it's just basically removed, and then the patient presumably just breathes like pure oxygen or or normal air ah during recovery.
00:06:37
Speaker
Exactly. they just wake up. Exactly. Okay. Yeah. And so... You mentioned EPO. What exactly is EPO for those of us that may not know what that term refers to? Well, you know, EPO is erythropoietin. It's the hormone made mostly by the kidney in response to low oxygen in the body. And it acts on the bone marrow to produce more red blood cells, which is a process that takes a while. I mean, it starts in a couple hours, but you really don't get an appreciable increase in red blood cells that will
00:07:13
Speaker
you help your anemia or improve your performance for weeks. So, um and as you well know, and as mountaineers and anybody in sports knows, synthetic EPO was developed for people with kidney disease who were anemic.
00:07:29
Speaker
And it's been used by athletes to increase the red blas so red blood cell count, or I like to say increase their hemoglobin in order to performance.
00:07:40
Speaker
But here's a key point that most, a lot of mountaineers don't understand. Both blood doping, infusion of blood, ah yeah you know, in preparation for a performance or, you know, naturally by, i mean, naturally injecting blood or using the synthetic hormone ah is only good at high altitude.
00:08:04
Speaker
It's only of benefit up to about 4,000 meters.
00:08:09
Speaker
Why is that? It's because after 4,000 meters, what's much more important than the amount of hemoglobin you have in your blood is the amount of oxygen that's loaded on that hemoglobin.
00:08:22
Speaker
Breathing is much more critical. Your blood oxygen level is much more critical than your hemoglobin level. And this has been shown egg experimentally in and in the field.
00:08:36
Speaker
And you know the Extreme Everest group that climbed Everest and did research after we did very nicely showed that at a certain point, the amount of hemoglobin isn't so important um and the amount of oxygen is.
00:08:53
Speaker
So it's a misperception that, i mean, if you use hypoxic tents, for example, to acclimatize, yes, you'll raise your hemoglobin level and it'll definitely help on the way into base camp.
00:09:06
Speaker
but it's not going help much above base cap. And what's more important is the other changes that take place with repeated hypoxic exposure, particularly the and increase in in breathing.
00:09:18
Speaker
And I think of there's a big misunderstanding that it's the red cells that are all important. It's not. yeah In fact, you could probably climb Everest with moderate anemia and probably do okay as long as you had a high enough oxygen level, oxygen saturation level.
00:09:36
Speaker
Yeah, and interesting. And I think a lot of the press around the use of xenon for as a pre-acclimatization shortcut has focused on its known, or and and maybe maybe again, maybe maybe i't maybe this isn't known, maybe I don't understand the physiology of xenon well enough, you know,
00:10:01
Speaker
acting as a stimuli to the the process. As you say, it's a four to six week process, right? From the stimuli to a mature red blood cell.
00:10:11
Speaker
And so that's obviously a very long time. But then, so it seems that if this is really working the way people have say been saying that it's working for them in some individual cases, specifically with Lucas Fortenbach, and I'm going to have him on in a separate episode and explore that with him, that there must be something else going on.
00:10:34
Speaker
It's not just it's the red blood cells, sort of a red herring. It feels like it's the the red blood cell count isn't the thing. it's There's got to be something else. to do with the the oxygen saturation of the existing blood. Like you just said, you could be mildly anemic and have low red blood cell count. And if your sats were good, you would be okay. I
Research on Xenon's Effects and Safety Concerns
00:10:58
Speaker
mean, that's your of your supposition. So what else could be happening here with this gas?
00:11:05
Speaker
Well, that gets, we could get into the weeds here. Yeah, that's okay. First of all, let's back up for just a minute and look at what we know about whether xenon actually increases EPO or Dow.
00:11:20
Speaker
Okay. And that's been shown in animals and humans that it does for a while. Okay. And...
00:11:32
Speaker
That was established. The next thing to establish was, well, does this increase in EPO produce red blood cells and increase hemoglobin levels as synthetic EPO would or as altitude training would, you know? and this was And so the study was funded by WADA.
00:11:52
Speaker
because they became alarmed that the Russians were using xenni gas. They didn't know if it was safe. They heard that it increased EPO. Their WADA rules, that's the World Anti-Doping Association, has banned EPO and other synthetic forms of erythropoietin as performance enhancing.
00:12:18
Speaker
So WADA kind of off the cuff, just banned xenon gas, but they did ah fund some research and ah Justin Lawley and Ben Levine, colleagues of mine at yeah University of Texas Southwest, they did a really nice study looking at daily xenon use and intermittent xenon use in athletes and looked at EPO levels. And yes, EPO went up.
00:12:45
Speaker
But in their four week study of using a dose of xenon every day, interestingly, there was no increase in hemoglobin or in exercise performance, which raises more questions than it does answer. So they concluded that, okay, you get a little bump in EPO for a little while, but it doesn't seem to make any difference in performance.
00:13:09
Speaker
Um, but WADA banded anyhow, is my understanding. So the question remains open. And, and, you know, with these studies, there's all sorts of, what dose of, of xenon are you going to use? How long are you going to use it?
00:13:25
Speaker
How many times a week or month or whatever? so you there's all sorts of permutations that haven't been studied. And, um,
00:13:38
Speaker
So we get back to the question. ah So I just i just had to put that as groundwork. Yeah, that's super interesting. The bottom line for you and for all climbers to know is that it's not well established that xenon actually raises red cells.
00:13:54
Speaker
It's not at all well established that it raises exercise performance. There was one study with an NF1, and that was Lucas Furtenbach, and he studied it on himself. So, you know,
00:14:08
Speaker
That's fascinating. And I congratulate him for thinking of it and doing of it but and doing it. But, you know, is that, are climbers going to adopt it based on that one experience with one person?
00:14:19
Speaker
i don't think so. We certainly wouldn't in any kind of medical practice. or So it needs to be studied. Now, sorry, to get back to your other question, what else could it be doing? Well, yeah there's a researcher ah by the name of Fries in, I think he's Austrian.
00:14:38
Speaker
who approached Furtenbach and he had been studying xenon gas as ah protective agent for the brain and other organs when circulation is, and stops.
00:14:53
Speaker
So cardiac arrest or stroke or heart attack, anything where there is no blood flow. Um, to an organ. And, you know, this is one of the holy grails of medicine is to find an agent that can protect organs that are compromised by lack of blood flow, like in heart surgery, for example, strokes, heartache, et cetera.
00:15:16
Speaker
So ah he worked with animals and he showed that indeed xenon was protective. If the animal had a dose of xenon, I forget, just prior to, or just after uh,
00:15:31
Speaker
the cardiac arrest or the cessation of blood flow, it helped preserve tissue. And other researchers have shown the same in other animal models. And that's really interesting.
00:15:42
Speaker
And that might turn into something to be used during heart surgeries where the heart is stopped and that sort of thing, or in strokes. I don't know. But that's a long ways from protecting the brain from blood flow, but blood flow with low oxygen. They're not the same.
00:16:01
Speaker
And this is a common confusion in the medical literature as well as in various communities. Stopping all blood flow and having reduced oxygen, having no oxygen, is much different than having very low blood oxygen levels, but having some blood flow.
00:16:20
Speaker
And all sorts of studies show you can tolerate a very low oxygen level. I mean, look, you've been on the thousand meter piece without oxygen your arterial po2 was about 25 to 26 and humans aren't thought that they could survive at that level of uh what we call hypoxia so um there's a lot we don't know and uh there's a lot to learn whether
00:16:49
Speaker
Anyhow, he approached Furtenbach and said, you know, I found that this is my understanding. You should talk to Lucas, but it's my understanding that he showed him his studies, which was really good and interesting for protecting tissues that were stored oxygen.
00:17:04
Speaker
And he suggested, as I understand it, that Lucas try this on the mountain and Lucas tried it and said, wow, it really made a difference. So we need to find out more about that.
00:17:15
Speaker
And it it hopefully will lead to some really interesting research. You know, it needs to be funded well-funded research because it's very expensive stuff. yeah And and and there's ah there's a couple of things that anybody wants to know more about this or consider he needs to know. One is that
00:17:37
Speaker
It's potentially lethal, you know, just like nitrous oxide or ketamine. If you give too much, you're going to kill yourself. ah It should be administered only by somebody who knows what they're doing and preferably with an anesthesia machine, with medical monitoring.
00:17:53
Speaker
And my understanding is that what Lucas is going to do with his clients from the UK, it's safe. It is safe. yeah You know, the original article that was published on the athletes came out, and I think the UIA statement came out and said, oh, this is really dangerous. and Well, yeah, if you were to just...
00:18:14
Speaker
go online and buy a liter of Xenon and suck it in. and God knows what's gonna happen. So, you know, we wanna, there's no role for that, right? right I mean, that's potentially deadly.
00:18:25
Speaker
So you need an anesthesiologist or a skilled physician, you need a machine, you need the gas, and you need medical monitoring. Okay, that's probably the most important thing to get across.
00:18:36
Speaker
And it's probably not pure xenon, right? Because it needs to be, like you said, it's probably 78% xenon and 22% oxygen or or whatever whatever it is. they're still they're They're not going into full hypoxia, ah they getting choked off.
00:18:52
Speaker
That's right. ah Ben and those guys studied 30%, 50%, and 70% different dosages. Okay. different dosages okay And what they did was that the different dosages for breathing for two minutes, it just, this is a good example. They had people had to pull a lever.
00:19:09
Speaker
That was the exercise that they had to do. And they would tell them, okay, you know, 20 seconds after the gas started to pull a lever, 30 seconds, pull a lever. And at like 60 seconds, nobody could pull a lever anymore, you know, because they're unconscious or starting to go unconscious.
00:19:25
Speaker
So you say, you don't want to, You know, it's potent. It's a potent gas. um So where were we? Oh, yeah. So if anybody's considering that, then the second important thing is that we really don't know.
00:19:42
Speaker
Yeah. you know have I mean, Furnabach tried it and had great results. Oh, great. Well, you know one guy went over Niagara Falls in a barrel and survived, too, and he had great results.
00:19:53
Speaker
You're going to try that? Yeah. You know, it it needs more work. I mean, I respect Furtenbach. I think he's, you know, I really do. But yeah I'm sure he admits that, ah you know, this ought to get some more research before it's applied.
Need for Controlled Experiments on Xenon
00:20:10
Speaker
And then the third thing is you've got to be careful of claims that this could be yeah useful.
00:20:19
Speaker
And no diss on anybody, but... If you're going to Everest and you're gonna sleep in a hypoxic tent for two months before you go, so that that you'll be acclimatized to the altitude of 4,000 or 5,000 meters anyhow, and you can get into base camp much more quickly, and then you start to climb and you can go high flow supplemental oxygen as low as 6,000 meters 6,200 meters,
00:20:46
Speaker
sixty two hundred meters And you go up and on oxygen the whole come down the hallway and helicopter back and you're back in Katmai-du in a few days.
00:20:58
Speaker
Have you proven that xenon had anything to do with it? You know? Yeah. So thats that's why we like to do what we call controlled experiments, where you would study just the effect of xenon.
00:21:12
Speaker
Because we know, i mean, I've been saying this for decades, and I think you've heard me say this. Yeah. What is it about Everest? It's the altitude.
00:21:23
Speaker
You know, if Everest Base Camp were on the shores of Alaska, like in the fair weather range, the peak would be 3,500 meters tall. It's not even pretty. People wouldn't even want to go to it.
00:21:36
Speaker
There would be minimal difficulty. and But if it were the highest peak in North America, thousands would climb it, right? right So it's an altitude problem and the body needs time to acclimatize and you're really pushing the extent of of what humans can do with hypoxia.
00:21:52
Speaker
So if you take away the hypoxia, that is you start on oxygen, you can fly into base camp, slap on the oxygen, go straight up to camp two or the first day or camp one or two, stay on oxygen, go straight up to the summit and come back down. You can do it all.
00:22:10
Speaker
and In three days, if the weather's good, even faster if you're super fit.
00:22:16
Speaker
I've been saying that for decades. So what does that prove? you know i mean, so anyhow, with the hypoxic tent and the high flow oxygen at a relatively low altitude, you don't need anything else.
00:22:29
Speaker
Yeah. Yeah. Yeah. And I'm smiling because I've said some more things that I think that I could... you know and probably tomorrow, if I had a foolproof oxygen delivery system and I could breathe, yeah the the and the kits are so much better than they were in 1981. I mean, you you guys used back then compared to you know how good those masks are now is is incredible, right? And they're delivering, all the kinks have been worked out of that system, right? And if you know could deliver six or eight liters a minute,
00:23:06
Speaker
what's the actual altitude, right? Like that that could could be ah could be the actual thing that's going on. So had known risks.
00:23:18
Speaker
By the way, we have new data that I'll ah share with you. and would like to share with you at some point about, ah from a chamber study showing what the equivalent altitude is at various flows of oxygen at 8,000 to 8,800 meters.
00:23:32
Speaker
eighty eight hundred meters Oh, interesting. Yeah, I'd be very, very interested to know what that is. you guys ah have but so Can you tell us? Or is this not published? or i want to lower things It's not published yet, but I can tell you that I can tell you that 8,000 meters and above one liter permitted is adequate for sleeping or at rest.
00:23:56
Speaker
And two to three liters is adequate for most climbing. You don't need, for six is a total waste. Even four is kind waste, but, and yeah, well, that'll be coming out later.
00:24:08
Speaker
Okay. Yeah. I'd like to know when that comes out, we'll help talk about it, help you talk about it. Yeah. So just to kind of recap, because we've covered a lot of ground, we do know of sort of at least the short-term risks around using xenon. Like you said, you could i like pass out and die if you didn't know administer it properly.
Ethical Considerations in Climbing Aids
00:24:32
Speaker
we know anything about the long-term effects of using xenon in any capacity?
00:24:41
Speaker
Uh, no, not that I know of. I've never seen anything written about long-term effects. Okay. I don't think, i don't think there would be any, it's considered safer than nitrous oxide.
00:24:53
Speaker
And, um, I've never seen any long-term effects. And I suppose there are, but I mean, there might be, but not, not from these brief intermittent inhalations. I don't think there'd be any.
00:25:07
Speaker
ge Do you think that there is – if you think about the potential around research with this gas, do you think that there is a potential valid medical – potential valid medical use for for xenon in treating altitude illness or and helping people climb in any way?
00:25:31
Speaker
ah certainly not in treating an altitude illness. There's nothing that's going to be close to oxygen. that's really all you need. um in terms of acclimatizing, I mean, that's what we're talking about. Uh,
00:25:48
Speaker
I think it ought to be studied. i think it it deserves, uh, more investigation. That's my own feeling. And I know some of my colleagues say poo poo, just, you know, spend your money somewhere else.
00:25:59
Speaker
But, um, I'm intrigued Fernbach's observation, and I think it needs to be followed up with some science. And as you have pointed out, the the coaches and athletes are way ahead of the scientists when it comes to performance and these sorts of things. So we get our ideas from...
00:26:18
Speaker
yeah You know like the Russians showed up with it at Sochi. So we got the idea, oh, man, maybe we should study this. Yeah, maybe this has an effect. They've already figured out what the effect is. And I think that that's that's an important thing because I think that there's a lot of people want to follow science, right? But yeah also people need to understand that, you know, I'll use the sports example, that coaches and athletes are you know competing on a weekly, monthly basis over sometimes decades, over careers, and they're trying all kinds of stuff.
00:26:51
Speaker
And just through that sheer volume of trial and error, they're able to figure out in testing and in competition sort of what helps and what doesn't. And they know that things like good nutrition, lots of sleep, like you know sting, you know there's there's certain things it's like...
00:27:09
Speaker
if If it helps to sleep deprived to perform better, we would have found that out and maybe all the athletes would be sleep deprived for every competition. And then we would come along later and do the studies and sort of figure out why, what's what's working. And I think that um when, as a community, in a case like this, we want to look to the science and we want to say like, hey, does this work? Is this okay?
00:27:34
Speaker
And the reality is that this is the way it happens, that some somebody gets a An idea, they get an inkling that, you know, whether it's from the Russians or whether it's the doctor, I forgot, but the Austrian doctor or maybe he's German that you mentioned earlier that did the studies on the animals.
00:27:52
Speaker
Mm hmm. And then like, hey, let's, let's, what, what about this? What about this application? Let's try it, you know? And, and then maybe, maybe it works. And then we find out, okay, this, there's something here. Like clearly, clearly Lucas is onto, feels very strongly that he's onto something. He's betting his reputation, his business, his everything, his life on this.
00:28:18
Speaker
And, you know And to your point, maybe it's only the effective delivery of actual oxygen. Maybe that's the secret ingredient.
00:28:29
Speaker
Maybe has nothing to do with xenon at all. Maybe the xenon is smoke and mirrors, so to speak, because it makes it feel like you have something exclusive, unrepre unreproducible formula. But that's a very cynical view. I don't think that any of us feel like, you know, Lucas is part of our our community. And, you know, ah I don't think any of us feel like any of us are that cynical to try something like that.
00:28:56
Speaker
So theyre they're there there's i'm ah I'm with you. I think that there's something to it. I think we don't know what it is. i think it's going to be years later.
00:29:07
Speaker
before we find out. and i But I think in our lifetimes, we will find out. And i don't know if that is in four years or 10 years, but it's not going to be next week. No, no.
00:29:18
Speaker
and It's not going to be in time for people listening to this podcast that want to use it to climb Everest, you know, or maybe not, but it depends on their age. But I think i agree. It's very important to be open-minded.
00:29:32
Speaker
As scientists sometimes aren't as open-minded as you think they might be. And it's important to pick up on the things that are happening in the field and that are reported as even unique experiences.
00:29:46
Speaker
ah it's most important to make sure that it's not dangerous and people are going to be, you know, you don't want to like a tick tock trend, right? Where all sorts of nonsense is going on that could be potentially harmful.
00:29:59
Speaker
So one thing nice about mountaineering is there is a very strong tradition of science in mountaineering. and All the initial mountaineers were scientists, you know, they were going there to study the atmosphere and barometric pressure and all that stuff. There's a long tradition.
00:30:14
Speaker
And,
00:30:17
Speaker
And you know sometimes that's how we stumble upon things. Other times it's just pure common sense like oxygen. and Other times we use it, we've discovered a drug works like Diamox that was based on an animal study and really nobody of course was using it for that, but you know it it varies.
00:30:34
Speaker
um Yeah. I mean, dima that's a great example. Like Diamox, those who don't know, is ah probably if you go to your family physician and tell them that you're going trek to Everest Base Camp, they're going to, you know, if they don't know this already, they're going to look it up and they're going to come back and say, hey, we're going to give you a prescription for Diamox. Here's the dosage. Here's, you know, it's a it's a ah well understood and commonly prescribed medication for to help people.
00:31:06
Speaker
prevent you're the expert i should let you say this but to prevent acute malum sickness or to to minimize the the symptoms and that came from tell tell me the story of how that came maybe is there anything and ah i'm curious if there are potential parallels to diamox and how this may unfold you know that's a good question and i should know that right off the top of my head ah I first became aware of it from yeah well, it had to do with this old controversy that dates back to the turn of the century in the early 1900s about whether acidifying the blood or alkalinizing the blood would be good for high altitude.
00:31:52
Speaker
And this was a big area of contention. And it turned out that there was some research on acidifying the blood ah found it useful, but it was with ammonium chloride, which was horrible to eat, and it never gained any kind of popularity.
00:32:12
Speaker
And then in the 1960s, a guy name of Dunn studied it, said, you know, maybe there's something to acidifying the blood to make, because when you acidify the blood, you cause the organism to breathe more.
00:32:26
Speaker
And that's key to high altitude acclimatization. So he studied dogs and sure enough, the dogs had higher oxygen levels. And I think that the first study was done in soldiers.
00:32:42
Speaker
And then... and sixty In 69 or 70, yeah, somewhere around that. And then 73, 74, I came along and did the first study on diamox in a large population of trekkers, 243 trekkers up at, you know, near the Everest base camp.
00:33:03
Speaker
And that, I mean, Steve, that was what, 50 years ago, 50 years ago and we still haven't improved very much on ages you know it works okay but it's not a gold standard and it uh it does prevent serious mountain sickness which is what you want everybody can get a little mountain sick and go on but you don't want to get serious anyhow um i don't see xenon for playing any kind of role in and that but who knows um i think it's more likely to be protected for acute severe hypoxia like balloonist or something like that but i don't know i mean more work more work needs to be done in science as you know science is very slow process so uh trial and error you got to reproduce results you know like the study that showed didn't that xenon did not
00:33:58
Speaker
improve hemoglobin or improve performance? Well, it was a good study, but it's one study with 12 subjects and it really ought to be repeated.
00:34:10
Speaker
Who's going to fund those kinds of studies? I don't know. that's That's always an issue. Yeah. Yeah.
00:34:18
Speaker
So I'm curious to kind of just change the approach a little bit and understand that in your view, where is the ethical line between supporting an adaptation that the body has to something like high altitude and pharmacologically engineering human performance?
00:34:40
Speaker
Yeah, well, and you know, that's a big issue. Um, As a doctor who's trying to keep people safe in the mountains, it's not much of an issue for me. i mean, yeah I have my medical ethics, which is to prevent morbidity and and mortality and keep people healthy.
00:35:00
Speaker
ah The... and i have moral issues but i don't have much in the way ethical issues around climbing i mean the ethics of climbing is determined by climbers you know it's a kind of a consensus of a culture opposed to moral issues and uh Climbing generally non-competitive. People aren't out there to, well, now they are with FKTs and things. but ah They're generally out there to enjoy themselves, to enjoy the mountains, to have a great time. They're not competing.
00:35:33
Speaker
Who cares what WADA says? This is not a WADA-sanctioned sport in that you're not competing for money or goods or things. so And so I don't have any qualms. I don't have any issue. is it sporting or not? If somebody wants to go to Kilimanjaro, they got two weeks off. and you know They can only do a six-day trip, for example. Hell yes, they got to take Diamox.
00:35:59
Speaker
That's only way. they' that's I mean, it improves their safety and success rate dramatically. And same thing. If somebody's going to Everest as a physician, I have to advise them to use oxygen.
00:36:12
Speaker
you know well i shouldn't say that i have to present all the risks and benefits of using oxygen or not let them decide for themselves uh but i don't understand a lot of this ethical stuff about yeah there can be a fine line between what supports adaptation so uh that means the climatization what supports a climatization
00:36:38
Speaker
adequate sleep, healthy healthy lungs, for sure. That's the most important. ah Gradual ascent to high altitude. What about hypoxic tents? Is that an ethical thing? WADA looked at it and decided they would allow it because why should the people that can go to an altitude training camp and come back have a big advantage over people that can't afford that but could use a tent? That was the rationale.
00:37:06
Speaker
And But then, you know, it gets a little murky territory and they certainly banned EPO. But just because WADA banned something doesn't mean climbers should not use it.
00:37:20
Speaker
So, I don't know. i'm all It's really not an issue it's really not an issue of and pharmacologically enhanced acclimatization. Acclimatization is what you want. Well, this is where it gets tricky.
00:37:36
Speaker
Your goal is acclimatization, unless you're going to climb with ah with oxygen and it doesn't matter. And anything that supports acclimatization, I think is good and good and You know, does blood doping support acclimatization? Well, it supports your increase in red blood cells, but we know it's not nearly as good as living at high altitude and spending more time at high altitude. And...
00:38:04
Speaker
know, people have an issue with they want to do something that's sporting, well, that means they're going to not use oxygen on their 7 or 8,000 meter peak. And they're, you know, they may use a sleeping pill to help them sleep, or they may use ibuprofen for a headache, but they're not going to use Diamox probably because that promotes acclimatization. But I, you don't know,
00:38:27
Speaker
What I find interesting is there are all these people that are, or a lot of them, who are spouting about, oh, it's not sporting use Diamox or dexamethasone, which we reserve for treatment as, you know, generally speaking, are the same ones that are using oxygen.
00:38:41
Speaker
mean, there's really only one drug that's been shown to reliably enhance performance at high altitude, and that's oxygen.
00:38:54
Speaker
And it has no side effects. It's safe. It is a drug. It's considered by the FDA a drug. And, you know, if you're going to use oxygen, don't talk to me about sporting for anything else or dexamethasone or anything else, yeah you know.
00:39:09
Speaker
And, of course, I advocate the use of oxygen because I think it's much, much safer. Of course. is that Yeah. Anyhow, it's a tricky conversation.
00:39:20
Speaker
It's a very tricky conversation. and you know one of the i myself have been on the other side of that in the past where I used to be very critical of people using oxygen or you know any kind of, let's say,
00:39:35
Speaker
um aid um and At the same time, i strongly believe in the mountains as being a place of freedom where I can do what I want while I'm going there on my terms. so And then it's like what immediately begs the question is like, so what right do I have to dictate the terms to someone else?
Climber Motivations and Ethics
00:39:55
Speaker
Right? Like ah freedom in the hills, that's the classic phrase that we all have used and all come up with around the sport. And I think that it really comes down to you know declare your aids and just do it for yourself, right? Like if you're gonna use all the things, use all the things, and but don't say you did it without without all the things when you really did.
00:40:21
Speaker
that's That's, I think, that's like less unclear, right? Now you're saying you did this climb without oxygen and without dexamethasone, without diamox, without xenon, but you actually did take all, employ all those means, then that's a problem, right?
00:40:36
Speaker
um And so as long as people are sort of saying... And I think that that's one of the things I respect with Lucas's approach. He is saying like, Hey, we're going to go do this. We're going to try this thing. I've tested it on myself.
00:40:49
Speaker
We don't know, you know, and it's declaring his aides, right? Like he's not saying, you know, he's not just sort of hiding that. And then He climbs Everest in a week with four people, and then everybody's scratching their heads like, how did you do that?
00:41:03
Speaker
is you know they He's explaining ahead of time how are he's going to planning to do that. And maybe it works, maybe it doesn't. Well, you're going to find out here in the next few weeks.
00:41:15
Speaker
Well, we're not really, though. Yeah, yeah you were doing fair. If you were doing just Xenon... And what ran up every single week. Yeah, holy cow, we would know xenon. But pre-eccolumatization and oxygen on the mountain, there's no way to know what xenon's doing.
00:41:33
Speaker
yeah Yeah, and they are doing those things. so That's where the controlled experiment comes in as being valuable. Yeah. yeah yeah
00:41:42
Speaker
Yeah, we've we've covered a lot of ground here. I think it's been really informative. And one of my goals with this is to really give people as much information as we have about this topic.
00:41:55
Speaker
My goal is not to make up anyone's mind for them or tell them how to think. It's just simply to provide information and let people make their own conclusions.
00:42:05
Speaker
And we've we've covered a lot of what we know. is there is there anything that you know personally and professionally, as a researcher, about not just xenon, but, well, specifically xenon, but also these types of non-oxygen, let's call them, drugs that that we should be aware of as a community that we should be thinking of we don't know really long-term effects we know some short-term effects we know it's expensive like there's some basic basic information out there um but what what other what other things of should we know
00:42:46
Speaker
a couple things uh one you touched on earlier and and that is how to assess the state of the art in terms of the science and whatnot. And, you know, in the UIA, the UIAA statement on Zenon came out pretty quickly and it stated that there's no evidence that it's beneficial.
00:43:09
Speaker
And um I think what people need to understand is that
00:43:15
Speaker
The absence of evidence does not mean that there's evidence of absence of effect. This is a phrase we use in science all the time. Yeah, it's not been shown to be helpful in the mountains. Why? Because it's never been studied in the mountains. Yeah.
00:43:32
Speaker
So chicken and the egg. Yeah, I mean... yeah Yeah. You know, so a clearer statement is no one has yet studied it in the mountains, so we don't know.
00:43:44
Speaker
yeah Which is the same as saying there's no evidence that it works, but it, you know, it's a little more accurate. So that's one thing. And, you know, as a physician, um i would advise my clients not to try it until that we have some sort of science and then we've figured out...
00:44:05
Speaker
whether it can really work or not, you know, that'd be my own advice. I, I'm generally an early adapter of new technologies and new therapies, but, uh, this is of a very powerful thing that may, and that costs a lot that may not be worth it unless we can show it, it can actually be of some benefit. So it'd be helpful to do a controlled experiment.
00:44:31
Speaker
The second thing um,
00:44:37
Speaker
Yeah, you know, i I got in high altitude medicine because I loved being in the mountains. And there there I was working for the Himalayan Rescue Association at 4,400, well, 4,200 meters in Nepal.
00:44:51
Speaker
and And, oh, my God, seeing know all these people come by getting sick, I thought, see, oh, I got the flu when they came to the Khumbu. I finally realized, wait a minute. This must be altitude sickness.
00:45:03
Speaker
That's how I started my career. ah like Where was I going with that?
00:45:10
Speaker
You know, it depends on people's motivation. If your motivation is going to the mountains in order to get away from technology and the world and find yourself and push your limits and meet chirpas or other cultures and immerse yourself in other cultures, and what's the big rush?
00:45:27
Speaker
You don't need any drugs, just plan an extra week on your trip and take time to acclimatize and you'll be very comfortable and you won't get sick. And, you you know, it takes seven to 10 days to start improving your exercise performance once you arrive 3,500 or 4,000 meters. So it's take that much time.
00:45:47
Speaker
it Then there's other people who are motivated that, no, they got to do Everest. They got to punch their ticket and they've only got two weeks to do it. And so they're going to pay a fortune in order to try to, you know, a totally different motivation.
00:46:01
Speaker
Yeah. Yeah. Yeah. And I think it's a slippery slope when we start evaluating or judging other people's motivations. Yeah.
Managing Risk in Mountaineering
00:46:10
Speaker
yeah yeah there's there's There's things that I've done in my life that I'm sure, especially in climbing them, most people would not do. They would think that that's ridiculous, like not put their foot in my boot.
00:46:23
Speaker
And that's okay, right? like and And I think it goes the other way too. yeah we Yeah, we don't want to be judgmental. On the other hand, we we watch with some horror i want use a strong word and what's happening on on the you know the great peaks and yeah um it's just not what it was 34 years ago when we first started of course you can say that about most things but um so yeah you have to learn to as put up with that and if you don't like the crowds you know
00:47:01
Speaker
go to the Northwest buttress of the Nidalee instead of the West buttress, or, you know, go yeah try a different route on Everest or different peak or something. Yeah. Yeah.
00:47:12
Speaker
Yeah. you know How is your own relationship with, risk changed over your career? Like, you know, you climbed Everest in 1981, you know, 111% to do so. Now it's, I don't know, had I don't know, thousands.
00:47:29
Speaker
Sometimes it gets that many cents on one day, right? So, yeah you know, how does that, how does that change over over your life? My assessment risk?
00:47:41
Speaker
Mm-hmm.
00:47:44
Speaker
Well, you know, with age, one gets more conservative and has other responsibilities and family responsibilities that didn't have when I was 33 Everest.
00:47:56
Speaker
um And like you, I've seen in a lot of my friends die and it's certainly sobering. So sure, the risk calculus changes as as we age.
00:48:12
Speaker
And what I'm really into is managed risk, you know like which is which is what I think all the climbers should be. In other words, really looking objectively at the risk of being realistic and then figuring out how to manage those and then deciding, then making a decision.
00:48:28
Speaker
um
00:48:31
Speaker
You know, is it, I mean, look at the last year at and Denali, a couple of guys from Colorado, they were living in Colorado, so they were at medium altitude. They thought they were well enough acclimatized to go from um the airstrip up to the 4,300-meter camp and ah very quickly, so they did it a day and a half.
00:48:57
Speaker
And then the guy died of altitude illness. Now, that was a risk that you could certainly foresee and easy to mitigate. You just put in two or three camps before you get to 400 or 300 meters, you know?
00:49:11
Speaker
ah So, you know, some of these risks are just based on ignorance, I guess. i mean mean, it's an incorrect risk assessment, you know? Right. Yeah. And that's one of the things I think with this Xenon topic that I want to bring more information to the topic because I think there's a lot of misinformation and just a vacuum of knowledge around this topic. And what I don't want to see is someone saying, hey, I want to set an FKT on Montblanc.
00:49:38
Speaker
um I heard Xenon is good. I get to get a hold of a bottle on the internet somewhere. And like what you said, and then they you know they there they are found dead and they're up.
00:49:48
Speaker
apartment in Chamonix the next morning because they you know didn't have all the tools. They just thought this was a shortcut to high performance. And I think that that's a that's a real risk, too, in this, right? like there's a lot The hype cycle is pretty high on this topic right now.
00:50:06
Speaker
And ah there's a lot we don't know. And I think when you talk to Lucas, you find out that... like you know He's a very smart, but also a very calculating person. I mean, ah any mountain guide becomes an excellent mountain you know manager of risk, especially when you're guiding in high-risk environments like 8,000-meter peaks. But and that that is their is, while it's sort of, let's say, a trade secret, it's also very...
00:50:37
Speaker
It's very deliberate and careful how they're approaching this. you know They do have medical doctors. They do have the machine. they They are doing it in a in a clinic or a hospital. I don't know. and They don't say. They don't have to say.
00:50:50
Speaker
And i think that that is really important context for for people to understand.
00:50:57
Speaker
Yeah, absolutely. but I mean, let's keep bit of it alive. and i have to see what happens. He might have somebody marketing a handheld xenon gas device, you know, in the next few months or something. God knows. Yeah, right.
00:51:11
Speaker
It can be really crazy. yeah there So, yeah. So I'm really glad that you're doing this podcast to tell people that there's lot we don't know about Xenon. It's very experimental and hold off until we get a little more experience with it.
00:51:28
Speaker
And yeah yeah yeah, I think that's that you're doing a great service. Well, because of because your help, thank you for that. So I've got to ask you the...
00:51:42
Speaker
touring with the Stones. I've heard some of these stories in the past. And you know first of all, just like, how did it come to be that that Peter Hackett became the tour doctor for the Stones?
00:51:57
Speaker
high altitude, you know, they were touring in Mexico city. They were worried about the altitude. So they gave me a call. That was 2006 on the bigger bang tour. We hit it off and then they decided they wanted a full-time doctor.
00:52:13
Speaker
And, ah so I'm one of, I'm one of three doctors that rotate through with them. And, I've been with now for 20 years going 20 years.
00:52:24
Speaker
and You know, it's, then it's a different kind of risk assessment
00:52:33
Speaker
and they have, ah they have a whole security team that protects them from the risks of, uh, you know, all, all sorts of things. Uh, but it's, uh, yeah, it's really interesting. And, uh, and it's been kind of, and it's been fun and, you know, they don't, it's not that much time. The only tour,
00:52:52
Speaker
They don't tour every year. They tour every couple of years, maybe for a few months. So it's not, it's not too bad. and And I can't say much about it. All right. Well, I expect, ah I expect a backstage pass in my future, Peter. That's all I have. Oh, for sure.
00:53:10
Speaker
For sure. If they ever tour it again. Yeah. Yeah, do they yeah that's that's maybe the more important thing is finding out where they're going to tour and where we could get tickets. I know that they were in not they were in Munich a couple of years ago. I don't know if you were at that show, but that was the last time there were I heard that them were close to where I'm sitting here in Austria. so Well, stay tuned.
00:53:35
Speaker
Okay, I will. Vienna has a lot of promise. All right. Okay. I'd love to get my boys, like Francie and Sepi, my kids are getting really into music. And my my older one, who's nine, last weekend asked me if I'd ever heard of a band called Metallica.
00:53:56
Speaker
Because it's his new favorite band. It's too much. I'm like, yeah, yeah, I know a little bit about that. so So they're going in a good direction. i think the stones are a critical part of that education, though. It's all part of it. Classics.
00:54:12
Speaker
Yeah. Classics. Classics. Classics. Well, thanks so much for your time and your expertise and your opinions. And, ah you know, it's such an honor to have you on here and helping to share your wisdom and hard-earned knowledge with this community. So thank you, Peter.
00:54:30
Speaker
Thanks, Steve. Good to see you again. Good to see you. All right. Okay. Bye now. Bye.